NPIMap

Organization Active NPI

Cassidy Medical Group - SW

  • Family Medicine Physician
  • Vista, CA
National Provider Identifier
1093882359
Registry record updated Oct 13, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
CASSIDY MEDICAL GROUP - SW
Practice address
2095 W Vista Way Ste 218
Vista, CA 92083-6029
Phone
(760) 630-3562
Fax
(760) 630-2559
NPI assigned
Nov 29, 2006
Last updated
Oct 13, 2010By the provider in NPPES
Organization subpart
Yes
Parent organization
CASSIDY MEDICAL GROUP INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 13, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Judith M Krueger
Title
Executive Director
Phone
(760) 630-5487

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

2095 W Vista Way Ste 218
Vista, CA 92083-6029

Mailing address

2095 W Vista Way Ste 218
Vista, CA 92083-6029
Phone (760) 630-3562

Other identifiers 2

IdentifierTypeStateIssuer
GROO60602MedicaidCA
3016OtherCANEIC SITE ID, NSF BA0-7

National Provider Directory

National Provider Directory
Tax ID family
Cassidy Medical Group Inc5 organizations share this tax ID, including this one
Part of
Cassidy Medical Group Inc

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1286928000000",
    "number": "1093882359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2095 W VISTA WAY STE 218",
            "city": "VISTA",
            "state": "CA",
            "postal_code": "920836029",
            "telephone_number": "760-630-3562",
            "fax_number": "760-630-2559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2095 W VISTA WAY STE 218",
            "city": "VISTA",
            "state": "CA",
            "postal_code": "920836029",
            "telephone_number": "760-630-3562",
            "fax_number": "760-630-2559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CASSIDY MEDICAL GROUP - SW",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CASSIDY MEDICAL GROUP INC.",
        "enumeration_date": "2006-11-29",
        "last_updated": "2010-10-13",
        "status": "A",
        "authorized_official_last_name": "KRUEGER",
        "authorized_official_first_name": "JUDITH",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "760-630-5487"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GROO60602",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEIC SITE ID, NSF BA0-7",
            "identifier": "3016",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vista, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.